Can methadone help win the fight against HIV?

Can methadone help win the fight against HIV?

Santi W.E. Soekanto, Journalist, Denpasar, Bali

"I am exhausted," a gaunt man in his late 30s said quietly. For
the past 16 years he has been on the roughest ride imaginable,
getting on the wagon headed for sanity only to fall off again and
again into a heroin-induced abyss.

He has been merely existing between the intense pain that
flares up inside him to get the fix he needs from shooting heroin
into his veins and the brief respite before the pain again
becomes intolerable.

In early February, an anti-AIDS activist here informed him
about a new project sponsored by some UN agencies campaigning
against the spread of HIV through the sharing of unsterilized
needles among heroin users. Desperate for help, he went to a
small, neat, white-washed clinic at Sanglah Hospital where other
drug users were being given methadone -- a substitute for heroin,
which is expected to reduce the risk of HIV as it is given
orally.

"I only want to be cured. I have been taking heroin for years
only to blot out the pain -- we don't get anything out of it. Are
we afraid of HIV? When we need a fix, we aren't afraid of
anything. HIV is the last thing on our mind," he said.

Several sessions at the methadone clinic succeeded in
introducing a semblance of stability into his life. Then, he
began to have fears. "Only when we sobered up did we think about
the fears; fear of the police, of getting HIV. How can I know for
sure that I am not already infected with it?" he said.

Another younger drug user, nodded vigorously in agreement. "I
have been an addict for ten years. I have tried everything and
gone everywhere to try and stop this addiction," he said.

"I've been on methadone for two weeks and I already feel a
difference. Already the pain of withdrawal has lessened. I still
feel the urge to inject, but (it's) much less now as I have been
keeping myself busy by doing exercises."

Yet another drug user said: "Methadone has helped me by
introducing a period of rest into my life, and only now am I
scared to hell of AIDS because for years I have shared needles
with my friends."

The men, who requested anonymity, were among a group of drug
users who met with a visiting team of doctors and experts from
the World Health Organization (WHO) Indonesia, Sanglah Hospital
and other health facilities who shared a concern about the
rapidity with which HIV was spreading in the country among
injecting drug users (IDUs).

The project mentioned by the men was the methadone maintenance
treatment (MMT) in Bali and Jakarta. The concept is harm
reduction, a fairly new approach to curbing the HIV epidemic that
is now replacing other approaches, namely supply reduction and
demand reduction.

"The supply reduction approach has proven to be not so
successful, whereas the demand reduction approach, which
concentrates on prevention, treatment and rehabilitation, too,
has not fared as well as we wished," Dr. Satya Joewana, a
psychiatrist at the Atma Jaya University Medical School, told The
Jakarta Post.

"Studies of those approaches have shown that many drug abusers
tend to relapse again and again," he said.

"Our main concern is that drug addicts are the main tool for
the spread of HIV. More people today are infected through needle
sharing than through sexual transmission."